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DOULOS ENVIRONMENTAL COMPANY <br /> SAMPLING INFORMATION SHEET <br /> Client: Ultramar Sampling Date: <br /> Site: Beacon #6LO Project No. : 94-610-01 <br /> 3300 Waterloo Road Well Designation: MW- S <br /> Stockton CA <br /> Is setup of traffic control devices required? YES time; <br /> Is there standing water in well box? hours <br /> Is top of casing cut level? YES Above TOC Below TOC <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (zn inches NO If no, see remarks <br /> Well cover type: 8" UV 12" UV } <br /> 12" BK 12" DWP ~~ Z2" EMCO 8" BK <br /> CNI <br /> General condition of wellhead"assembly: ExcellentOther Z ' 100" C O <br /> Fair Poor <br /> Purging Equipment: 2" disposable baler <br /> 2" PVC bailer Submersible pump <br /> Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: S Teflon bailer: <br /> Well Diameter: 2" 4"-/\ '` 6" 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 <br /> 1. 47 2 . 61 gal/ft. <br /> Initial Measurement <br /> 2 2 Rechar a Measurement <br /> Time: l <br /> Depth of well-- gR 3 9 Time: <br /> Calculated purge: 13 f <br /> Depth to water- <br /> Depth to water• r <br /> Start purge:_ Sampling time:—L-' 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> I <br /> �� � z <br /> �� 3 <br /> t o � r �f <br /> Sample appearance: GSL Lack: 3 •]S 3 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: <br /> 6" Locking Cap: 9/16 Bolt:��� <br /> Pinned Allenhead (DWP) : <br /> Remarks: <br /> i <br /> Signature: � � <br />